The Minister of Health and Social Services, Christian Dubé, is faced with a titanic challenge. As for Asterix in front of his 12 works, now he is being asked to resolve the crisis of congested emergencies in record time, an issue on which many of his predecessors have failed. And to make matters worse, it must work magic at a time when there is a complete shortage of personnel and the aging of the population heralds an increase in needs.
So it’s semi-cynical — why would it work this time? — and half-optimistic — but what if this time it worked? — that we observe the crisis unit set up by Minister Dubé. It has just delivered its first fruits. Three measures were announced Tuesday in response to the cry from the heart that the heads of hospital emergencies in the greater Montreal region launched, and twice rather than once. They claim that the situation has now reached the “breaking point” and that the consequences will affect patient safety, if it has not already.
With occupancy rates approaching 200%, emergencies are cracking. Patients waiting for emergency services wait an undue amount of time in the corridors while on the floors, patients occupy beds unnecessarily, since they no longer need the care offered by the hospital, but are waiting for a place in accommodation that does not come. It’s squaring the circle, health care version. Add to that a shortage of nurses, the lack of 1,000 doctors and the staff who burn themselves out working in a dysfunctional system, and the breaking point picture is complete.
Christian Dubé cut his teeth on a pandemic, and he executed pretty solidly. It seems to approach the challenges of health in a pragmatic way, according to a field approach. This undoubtedly brings him closer to the solutions, because the all-out protection regime of the filthy bureaucracy has obviously produced nothing in the past, to the point where Minister Dubé, frankly, said of the measures he is initiating this week that “these are solutions that we have known for a long time, but that we have not implemented”. It’s chilling. The challenges ahead are daunting: unclogging emergency rooms, mitigating the effects of staff shortages, finding accommodation resources, improving the supply of home care, allowing all Quebecers who so wish to have access to a family doctor. Among other things !
The crisis unit therefore came up with three ideas: at the end of the 811, offer sick 0 to 17-year-olds access to an appointment; open two new specialized nurse practitioner (IPS) clinics in metropolitan France; create 1,700 places in CHSLDs or intermediate resources (IR) to free up beds occupied without reason in the hospital. Will these seemingly very beneficial solutions sooner or later come up against the wall of a lack of staff? How will doctors, who have already been called upon since the spring for the adventure of the first line access window (GAP), find new time slots for the appointments that the 811 line will offer for children? It’s a mystery we want to believe.
And if we want to believe in it, it’s for the citizen, who will soon end up believing himself in “the house that drives you crazy” (a reference to the 12 labors of Asterix) to seek THE doctor in bureaucratic labyrinths to make lose all hope. Could we blame him, this poor patient who is sick and desperate to find a door to knock on, for going to get lost in the gloomy waiting for the emergency even if his discomfort does not justify it, because he has not found anything better than this last-ditch zone forced to accommodate it? One out of two patients chooses emergency for lack of anything better, and it only encumbers emergency physicians who are worried that they will no longer be able to properly treat “real” urgent cases.
But, again, can we blame these wandering patients? Some — the lucky ones — have a family doctor, but they never manage to see him when it’s urgent, because only appointments made three months in advance are accessible to them. Others, the orphans, have been hoping to be “called” for months to be offered medical management by team, this new collective care, which signals the failure of the policy of one doctor per citizen. Between these official categories, there are all those who are nowhere and who dial all the numbers in the hope of reaching a general practitioner, sometimes simply to renew a prescription.
While the patient, regardless of the severity of his illness, wears himself out looking for the right care in the right place at the right time, the employees of the health network are no doubt also trying to stay the course and the hope that one day the problems will lessen. The desertion of the network by overwrought and exhausted staff would only aggravate the situation. Let’s hope that the crisis unit will be connected to reality so that its game plan really sees the light of day.